化瘀通窍方辅助西医治疗低灌注/栓子清除能力下降型脑梗死疗效及对血液流变学、凝血功能的影响

Curative effect of Huayu Tongqiao decoction with western medcine on hypoperfusion/decreased embolus clearance cerebral infarction and its effect on hemorheology and coagulation function

目的探讨化瘀通窍方辅助西医治疗低灌注/栓子清除能力下降型脑梗死疗效及对血液流变学、凝血功能的影响,为中西医结合方案应用寻找更多医学证据。方法将102例低灌注/栓子清除能力下降型脑梗死患者随机分为2组,对照组51例给予阿司匹林(0.1 g/次口服,1次/d)+辛伐他汀(40 mg/次口服,1次/d)+长春西汀(20 mg/次静脉滴注,1次/d)治疗,观察组51例在此基础上辅以化瘀通窍方治疗,2组均治疗14 d。观察2组治疗前后临床证候评分、美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数(BI)评分、经颅多普勒血流[责任侧血管峰值流速(Vs)和平均血流速度(Vm)、血管阻力指数(RI)、平均通过时间]、血液流变学指标及凝血功能指标变化情况。结果2组治疗后临床证候评分、NIHSS评分、RI和平均通过时间、全血黏度、血浆黏度、血小板聚集率、血管性血友病因子及纤维蛋白原水平均显著降低(P均<0.05),而责任侧血管Vs和Vm均显著加快(P均<0.05),凝血酶原时间、活化部分凝血活酶时间及凝血酶时间均显著延长(P均<0.05),且观察组各指标改善情况均显著优于对照组(P均<0.05)。结论化瘀通窍方辅助西医治疗低灌注/栓子清除能力下降型脑梗死能够有效缓解症状体征,减轻神经功能损伤,提高生活质量,增加脑部血流灌注量,并有助于改善血液流变学及凝血功能。

Objective It is to explore the curative effect of of Huayu Tongqiao decoction with western medcine on hypoperfusion/decreased embolus clearance cerebral infarction and its effect on hemorheology and coagulation function,and to find more medical evidence for the application of integrated traditional Chinese and western medicine.Methods 102 patients with cerebral infarction with low perfusion/decreased thrombus clearance ability were randomly divided into two groups.51 patients in the control group were treated with aspirin(0.1 g/time,once a day)+simvastatin(40 mg/time,once a day)+vinpocetine(20 mg/time intravenous drip,once a day).51 patients in the observation group were treated with Huayu Tongqiao decoction based on the control group.Both groups were treated for 14 days.The changes of clinical syndrome score,NIHSS score,Barthel index(BI)score,transcranial Doppler blood flow(Vs)and mean blood flow velocity(Vm),vascular resistance index(RI),mean transit time(MTT),hemorheological indexes and coagulation function indexes were observed before and after treatment in the two groups.Results After treatment,the clinical syndrome scores,NIHSS scores,RI and mean transit time,the levels of whole blood viscosity,plasma viscosity,platelet aggregation rate,von Willebrand factor and fibrinogen were significantly decreased in both groups(P<0.05),while Vs and Vm in the responsible side were significantly accelerated(P<0.05),prothrombin time and activation partial thromboplastin time and thrombin time were significantly prolonged(P<0.05),and the improvement of each index in the observation group was significantly better than that in the control group(P<0.05).Conclusion Huayu Tongqiao Decoction combined with western medicine can effectively relieve symptoms and signs,alleviate neurological impairment,improve quality of life,increase cerebral blood flow perfusion,and help to improve hemorheology and coagulation function in the treatment of cerebral infarction.